li>*Ensures that staff advocates for proper placement within the scope of the role of the UM by arranging for, or directly reaching out to, Primary Care Providers (PCPs), specialists, hospitals, local mental health services, the managed care behavioral health organization (MCBHO), local care management programs, and community agencies to maximize UM's outcomes.
GENERAL SUMMARY:
Leads and shapes the Utilization Management (UM) Strategy for Bryan Medical Center (BMC) while providing management oversight in implementing, directing, and monitoring the Utilization Management Department functions, including prior authorizations, concurrent review, medical claims review, and appeals and grievances.